The Illinois Department of Public Health Laboratory Services Manual provides a description of all clinical tests available at the laboratory and other useful information.
The Laboratory is certified under the Clinical Laboratory Improvement Act (CLIA) for clinical testing by the Centers for Medicaid and Medicare Services.
Test Request for Blood Lead Analysis Instructions
This form has been designed for data to be typed electronically. This is the preferred method. If filling out the form by hand, print legibly and in the spaces provided. This will eliminate scanning errors of your sample information, which could delay the reporting of your results. USE CAPS ONLY.
When electronically filling in fields that contain dashes or backslashes, click your mouse pointer on the dash or backslash to select the field and enter the information. Selecting the field itself will not allow you to enter the information, select the dash or backslash.
Each sample must be clearly labeled with the complete patient name and birthdate. Use only one form per each sample. Incorrectly labeled sample tubes may not be tested.
Clear buttons have been placed throughout the form. Use these buttons to clear these areas. This will assist you if you need to fill out multiple forms.
At the bottom of the page you will find buttons to clear or print the form. The print button will print current information on the form. The clear button will reset the form for re-use.